Osteoarthritis – a slow-progressing, degenerative condition

OSTEOARTHRITIS is the most common form of arthritis, affecting millions of people globally. The slow-progressing degenerative condition, which medical internist Dr Samantha Nicholson said does not have a singular causative factor, is described as the inflammation of joints and other components including the cartilage, joint lining, ligaments and bone.

“There is no one cause for osteoarthritis. What you have instead is a number of contributing factors that increase your likelihood of developing the condition such as obesity, age, wear and tear from repeated and excessive use of joints, previous joint injuries, sports, especially if you have been doing it for a number of years, from childhood, for example, jogging on pavements and genetics,” Dr Nicholson outlined.

She explained that the inflammation occurs for a number of reasons, but ultimately when the cartilage — which is the slippery tissue that cushions the ends of bones in your joints — wears thin, it causes bone-to-bone contact. This creates friction which leads to irritation and inflammation resulting in pain.

“Apart from reduced cartilage, in osteoarthritis patients, other changes include narrowing of the joint face which causes a lot of friction and reduction in synovial fluids in the joints, the part of the bone close to the joint can also become swollen and the area may look deformed. This deformity is usually seen in the knuckles of elderly people with arthritis,” Dr Nicholson said.

The medical internist also highlighted that while just about any joint in the body can be affected by osteoarthritis, some joints by virtue of the fact that most of the body's weight passes through them, are at greater risk of wear and tear and therefore more prone to developing the condition. These include the knee and spine. Other areas including the fingers and hip are also commonly affected since those areas also experience daily wear and tear.

Dr Nicholson notes that the condition, which has no cure, comes with the most common complaint being severe pain which is often associated with stiffness. The condition is therefore managed using painkillers and in some cases combined with topical ointments for relief.

“Painkillers such as acetaminophen or non-steroidal anti-inflammatories such as ibuprofen, naproxen (Aleve), Advil, Cataflam and Voltaren are recommended. You can also use topical ointments, which you would just rub onto the joint, such as tiger balm and the Voltaren gel,” Dr Nicholson instructed.

Another treatment option to explore is supportive treatment such as physiotherapy. To some extent, Dr Nicholson said this can be helpful since it contributes to better posture, and reduces pressure on any given joint. Applying a hot or cold pack also assists with pain relief. She said that you can also consider viscosupplementation — this is where lubricating fluid (usually hyaluronic acid) or other steroids is injected into a joint. She explains that this not only reduces the pain associated with the condition, but some experts suggest that it may even slow down its progression and facilitate better joint movement.

You may want to carefully consider your options before opting for steroid injections; however, because Dr Nicholson warned that while the steroids help to improve the strength of the joints and give pain relief, multiple injections of steroids over time also accelerates joint destruction and as such you will need joint replacement much sooner than you would without these injections.

There will be some cases, however, where these treatment methods aren't very helpful and as such the doctor may decide that surgery to repair, strengthen or replace damaged joints should be considered.

“The surgical options available include fusing the joints and the pain would disappear since there is no longer any bending or joint movement. However, this is not what is usually done because it creates a limp. The alternative is joint replacements such as hip and knee replacement therapies which are among the most common. Another option is the use of artificial material to bolster the joint,” Dr Nicholson outlined.

She reasoned that every treatment option has its place and should be carefully considered before a decision is made.

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